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Toxicology > Toxicology > Flashcards

Toxicology Flashcards

1
Q

salicylates fatal ingestion amount?

A

10-30g

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2
Q

activated charcoal for salicylates?

A

if within 1 hour

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3
Q

goal of treatment for salicylate overdose?

A

alkalosis, serum ph 7.5-7.59, urine pH 6.5-8

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4
Q

how does alkalosis work in salicylate overdose?

A

favors the unprotonated anion and is excreted in the urine, if protonated it can cross the BBB

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5
Q

Level when to use HD in salicylate OD?

A

severe sx, >120 mg/dl in serum, or >100 6 hr post ingestion

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6
Q

isopropyl alcohol acid base?

A

only osmolar GAP, no AGAP, no acidosis, but ketones in urine

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7
Q

breakdown product of isopropyl?

A

acetone- smelly breath

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8
Q

osmolar gap?

A

serum osm- calc osm, normal <10

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9
Q

calculated osmolarity?

A

2Na+BUN/2.8+glc/18

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10
Q

treatment for isopropyl alcohol ingestion?

A

fluids and pressors if needed

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11
Q

HD for isopropyl alcohol?

A

level >500, coma, resistant sx

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12
Q

ethylene glycol(antifreeze) breaks down into?

A

oxalate

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13
Q

oxalate effect? how does it look?

A

renal failure/ dumbell shaped crystals

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14
Q

Methanol breaks down into what?

A

formic acid

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15
Q

alcogol dehydrogenase does what?

A

methanol to formaldehyde

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16
Q

alcohol dehydrogenase is inhibited by what 2 things?

A

ethanol(level 100-150 mg/dl) and fomepizole

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17
Q

formic acid causes what?

A

blurred vision, photophobia, blindness, optic disc hyperemia

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18
Q

methanol and ethylene glycol acid base?

A

osmolar gap and AGAP

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19
Q

propylene glycol tox seen in what circumstance?

A

dilutent in lorazepam infusion

20
Q

propylene glycol acid bae?

A

AGAP, osmolar GAP, AKI, lactic acidosis

21
Q

CCB overdose tx?

A

calcium, glucagon, lipid emulsion, insulin .1-10U/kg

22
Q

why cant you use dialysis for CCB overdose?

A

highly protein bound

23
Q

tx for BB OD?

A

glucagon, lipid emulsion

24
Q

MC tx for BB OD?

A

atropine and fluids

25
Q

how does glucagon work in BB OD?

A

inc cAMP, inc contractility

26
Q

symtpoms of BB OD?

A

bronchospasm, hypoglycemia, AV block, bradycardia

27
Q

CCB OD tx?

A

high dose calcium, then high dose insulin, then lipid emulsion therapy

28
Q

MOA of high dose insulin in CCB OD?

A

increases ical leading to increase ionotropy

29
Q

high dose insulin dosing?

A

1U/kg bolus, then 1-10 U/kg/hr. make sure to fix K and glc prior

30
Q

pathophys of methemoglobinemia?

A

contains the Fe3 instead of Fe2 which shifts the oxygen dissociation curve left and has higher affinity for o2 and does not unload to tissues

31
Q

how to measure methemoglobinemia?

A

co oximetry levels with methemoglobin levels, >30% severe

32
Q

causes of methemoglobinemia?

A

topical benzocaine, dapsone, primaquine, rasburicase in G6PD patients

33
Q

tx for methemoglobinemia?

A

methylene blue

34
Q

patient with low sat that is not responsive to supplemental O2, but normal Po2?

A

methemoglobinemia

35
Q

MOA of acetaminophen toxicitiy?

A

overwhelming the glutatione conjugation

36
Q

time frame for giving charcoal in acetaminophen tox?

A

within 1 hour

37
Q

tx for acetaminophen OD?

A

16h NAC protocol

38
Q

poor prognostic factors with tylenol OD?

A

acidosis, renal failure, INR>6, grade III HE

39
Q

when not to use the Rumack Matthew nomogram?

A

chronic tylenol use, chronic alcohol use, preexisting liver disease, unknown time of ingestion

40
Q

treatment for heavy metal intoxication?

A

dimercaprol

41
Q

how does insulin work for CCB OD?

A

Chronotropy and ionotropy

42
Q

when to transfer to a liver center for tylenol OD?

A

early signs of hepatic dysfucntion or massive ingestion of >30g or a serum level of >500 mg/L

43
Q

ethylene glycol urine findings?

A

calcium oxalate monohydrate crystlas, dumbbell shaped

44
Q

initial management strategy for acetaminophen overdose?

A

if confirmed give NAC, dont wait for lab value

45
Q

best treatment for isopropyl alcohol intoxication?

A

IV fluids, HD reserved for levels over 500 and severe symptoms

46
Q

aspirin overdose electrolyte disturbances?

A

low serum uric acid, lactic acid from uncoupling, hypokalemia, AGAP acidosis, resp alkalosis

47
Q

complication from salicylate toxicity need to watch for?

A

hypoglycemia

Toxicology (4 decks)

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